Abstract

Background

The burden of cardiovascular disease and death has plummeted over recent decades in Sweden and comparable countries. But might it soon increase as a result of population aging? Few studies have formally investigated future stroke trends. The aim of this study was therefore to quantify the future burden of ischemic stroke in Sweden until 2030.

Methods

We developed and validated a discrete open cohort Markov model for ischemic stroke (IS) in the Swedish population. We used population data from Statistics Sweden, the Swedish inpatient registry and cause-specific death registries to calculate IS prevalence and absolute numbers from 2000 to 2010. We then estimated future trends in IS incidence and mortality rates until 2030 using a BAPC (Bayesian aged-period cohort) approach. We also conducted sensitivity analyses to better quantify uncertainty around model inputs and outputs.

Results

Overall IS prevalence was predicted to decrease by approximately 20% between 2010 and 2030, from 170 to 137 per 10 000 population and from 183 to 157 per 10 000 in men and from 157 to 116 per 10 000 in women.

Results

During the same period, the overall number of IS patients might fall by just 3%, from 1 27 000 in 2010 to 1 23 000 in 2030 (decreasing from 59 000 to 52 000 in women, and increasing modestly in men, from 68 000 to 71,000).

Results

Worryingly, the prevalence of IS in young people aged <45 years was predicted to increase from 5.4 to 6.7 per 10 000 population (the number of IS patients correspondingly increasing from 1970 to 2,610).

Results

IS prevalence in elderly people aged >85 years was predicted to fall by a third, from 1180 to 800 per 10 000 population. However, the actual number of IS patients might increase from 29 470 to 31,800, reflecting a growing elderly population.

Conclusion

Ischaemic stroke prevalence in Sweden might well fall by 20% between 2010 and 2030. However, the overall number of IS patients could remain above 1 20 000 per year. More worrying still, IS cases among the older citizens will increase due to population ageing, as will morbidity among the youngest groups. To reduce the future burden of stroke, Sweden needs a more ambitious and comprehensive prevention strategy.